Get Wa Doh 505-026 2020-2026

The WA DOH 505-026 form is essential for laboratories seeking a Certificate of Waiver for Medical Test Sites in Washington. This guide will provide you with step-by-step instructions to help you fill out the form accurately and effectively online.

Follow the steps to complete your application with ease.

1. Click ‘Get Form’ button to access the WA DOH 505-026 online application.
2. Begin by selecting the type of application: indicate whether it is a new application, change of ownership, or change of license type.
3. In Section 1, Demographic Information, input your Uniform Business Identifier Number (UBI #) and Federal ID Number (FEIN #) as required.
4. Provide the legal owner/operator entity name and complete mailing address, including phone, fax, email, and web address.
5. Enter the facility name, facility specific Federal Tax ID (if applicable), and physical address with city, state, zip code, and county.
6. Detail the primary phone and fax numbers for the lab, and a mailing address if it differs from the physical address.
7. In Section 2, select the site type from the provided options and list the hours of laboratory testing accurately.
8. If there are additional locations under this license, attach a list detailing those locations and associated tests.
9. In Section 3, provide key individuals' information, including the lab director and lab contact person, along with their license numbers and email addresses.
10. In Section 4, identify the waived tests performed by specifying the manufacturer(s) and test system(s).
11. Section 5 requires listing any other licensure, certification, or registration information such as corporate officers and change of ownership details.
12. Finally, sign the document, print the name and title of the legal owner or authorized representative, and ensure all information is correct before submission.
13. Once you complete the form, save changes, and prepare to download, print, or share the application as needed.

Complete your WA DOH 505-026 application online today to ensure smooth processing of your Medical Test Site license.